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Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Positive Patients in Sub-Saharan Africa

Authors

  • Judith A. Hahn,

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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  • Loren M. Dobkin,

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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  • Bernard Mayanja,

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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  • Nneka I. Emenyonu,

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    • Present address: Box 0886, University of California, San Francisco, CA 94143-0886.

  • Isaac M. Kigozi,

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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  • Stephen Shiboski,

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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  • David R. Bangsberg,

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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  • Heike Gnann,

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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  • Wolfgang Weinmann,

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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  • Friedrich M. Wurst

    1. From the Department of Medicine (JAH, NEI), University of California, San Francisco, California; Bixby Center for Reproductive Health (LMD), University of California, San Francisco, California; Faculty of Medicine (BM, IMK, DRB), Mbarara University of Science and Technology, Mbarara, Uganda; Department of Epidemiology and Biostatistics (SS), University of California, San Francisco, California; Center for Global Health (DRB), Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School (DRB), Boston, Massachusetts; Institute of Legal Medicine (HG, WW), University Medical Centre, University of Freiburg, Freiburg, Germany; Institute of Forensic Medicine (WW), Medical Faculty, University of Bern, Switzerland; and Department of Psychiatry and Psychotherapy II (FMW), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
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Reprint requests: Judith Hahn, Box 0886, University of California, San Francisco, California 94143-0886; Tel.: 415-597-4961; Fax: 415-597-9213; E-mail: judy.hahn@ucsf.edu

Abstract

Background:  Alcohol is heavily consumed in sub-Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth).

Methods:  Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 (n = 77). PEth in whole blood was compared with prior 7-, 14-, and 21-day alcohol consumption.

Results:  (i) The receiver operator characteristic area under the curve (ROC-AUC) was highest for PEth versus any consumption over the prior 21 days (0.92; 95% confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0% (95% CI: 76.0 to 95.6) and the specificity was 88.5% (95% CI: 69.8 to 97.6). (ii) The ROC-AUC of PEth versus any 21-day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women (p = 0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21 days (Spearman r = 0.74, p < 0.001) and BRAC (r = 0.75, p < 0.001).

Conclusions:  The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC-AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable.

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